‘Severe pressure’ on AMHPs amid job cuts, rising workload and bed shortages

Mental health social workers are “under severe pressure” as some councils cut their numbers of approved mental health professionals (AMHPs) despite rising workloads and demand for support, the Care Quality Commission has warned.

The 2011/12 edition of the regulator’s ‘Monitoring the Mental Health Act report’ found that 17,503 patients were detained under the Mental Health Act on March 31st 2012, a rise of 5% from the previous year. Some 4,220 people were subject to community treatment orders (CTOs), up 10% from 2010/11.

Falling AMHP numbers

The CQC found some local authorities had cut AMHP numbers, despite rising workloads in recent years. Mental health social workers told the regulator that the government’s work capability assessments had increased pressures on their caseloads alongside AMHP duties. One AMHP reported handling a social work caseload of 70 people in addition to carrying out statutory duties.

Statutory duties have also increased in the last five years, the regulator warned. AMHPs took on responsibilities for agreeing to and renewing CTOs on their introduction in 2008 and they may also be trained as best interest assessors under the Deprivation of Liberty Safeguards.

Steve Chamberlain, chair of The College of Social Work’s AMHP leads network and an AMHP in south London, told Community Care:

“The CQC findings chime closely with the findings of the national AMHP survey last year in which stress was widely reported, with statutory work becoming increasingly squeezed with little or no accommodation for the demands of care coordination.”

“Mental health trusts and local authorities must address this issue if AMHPs are to continue to work effectively and safely,” he added.

Bed crisis 

A continued shortage of mental health beds had put “services and patients under stress”, the CQC found.

In 2011/12, 93 wards (6% of all wards) visited had more patients than beds and a further 10% were at full capacity. In one service 27 patients were allocated to 19 beds – a move made possible by patients “sleeping out” in other empty wards.

Some AMHPs felt forced to detain patients under the Mental Health Act as a means of getting access to a bed, with certain hospitals having an “aversion” to voluntarily admitted patients.

The CQC saw “good evidence” of AMHPs seeking alternatives to hospital admission for patients. But many were  hampered by a “lack of alternatives” such as crisis houses or other staffed accomodation.

Martin Webber, reader in social work at York University and a registered social worker, said:

“It is clear from this report and the national AMHP survey that the Department of Health needs to tackle the bed over-occupancy problem and work proactively with local authorities to develop appropriate non-medical crisis care.

“The social work role within mental health services needs to be fully understood and respected. It is not just a sectioning service, as some perceive it. The therapeutic potential of mental health social work needs to be realised.”

A culture of ‘containment and control’

Other issues raised in the wide-ranging CQC report, include:

• Over a third of care plans inspected by commissioners failed to include discharge planning. AMHPs in parts of the country report that patients are being discharged from hospital too early, causing an increase in assessments and detentions.
  
• One in five patients seen by commissioners had not been informed of their right to an Independent Mental Health Advocate.
  
• An “unacceptably high” proportion of patients – more than a third – had not been adequtely involved in planning their own care.
  
• In one in five visits, commissioners felt voluntary patients had been “detained in all but name” with some placed in locked wards with little explanation of how they could leave.
  
• Despite some patients being able to access talking therapies, a lot of services were “too ready to rely on psychiatric medication” as a response to patients in distress.
  
• Detention rates for some minority groups, including black caribbean and black african, were between two and 13 times greater than expected.

Joe Godden, professional offcer at the British Association of Social Workers, said that “more and more pressure” is being placed on mental health social workers despite many of the issues flagged by CQC, including bed shortages, having been raised as concerns in previous research.

“It is totally unacceptable that the same issues recur as in previous similar reports, with certain practices actually getting worse,” he said.

David Behan, CQC chief executive, said that the regulator is concerned that “some hospitals have allowed cultures to develop where control and containment are prioritised” over treatment and care.

“We will be making mental health a high priority this year and the information gained though our Mental Health Act visits and from other strategic partners will direct our inspection work. Where we witness poor and unacceptable care we will use all the powers that we have to ensure that these practices change,” Behan said.

Related articles: AMHP survey analysis: ‘A depressingly familiar picture of an undervalued workforce’

Andy McNicoll is Community Care’s community editor